Join Howard and Janeen Arbuckle for this discussion of pediatric and adolescent gynecology essentials. Pediatric and adolescent gynecology is a newer discipline bringing specialized care to young women with unique gynecologic needs, with a focus on counseling, education, and age-appropriate interventions.

• Abnormal uterine bleeding in adolescents is rarely caused by structural problems (unlike in adults) and typically relates to immaturity of the hypothalamic-pituitary-ovarian axis
• Hematologic workup should be considered for adolescents with heavy menstrual bleeding as this may be the first time their clotting system is challenged
• Hormonal therapies are safe to use once menarche has occurred, with no impact on bone growth
• Long-acting reversible contraceptives offer superior pregnancy prevention (1 in 10,000 for implants vs 8 in 100 for typical pill use) but require thoughtful counseling
• Private interviews with adolescent patients create trust while preparing them for independent healthcare navigation
• Tranexamic acid is effective for heavy menstrual bleeding in adolescents but pill size and frequency can limit compliance
• Most ovarian cysts in adolescents represent normal physiologic function and rarely require intervention
• Preservation of reproductive organs should be prioritized in adolescent surgery, including leaving ovaries after torsion when possible
• Vaginal bleeding in pre-pubertal girls requires assessment for secondary sexual characteristics to distinguish precocious puberty from other causes

00:00:00 Introduction to Pediatric Gynecology

00:07:20 Abnormal Uterine Bleeding in Adolescents

00:19:36 Contraception Choices for Young Patients

00:29:40 Managing Difficult Patient-Parent Conversations

00:38:04 Pelvic Pain and Endometriosis

00:46:58 Adnexal Pathology and Ovarian Issues

00:50:51 Congenital Anomalies and Vaginal Bleeding

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In this episode, Antonia and Howard explore the groundbreaking study on treating male partners for bacterial vaginosis, revealing significantly reduced recurrence rates and challenging our traditional understanding of BV pathophysiology.

Plus:

• Evidence doesn't support treating mild gestational hypertension with antihypertensives
• Studies confirm acetaminophen in pregnancy doesn't cause ADHD or autism
• New research questions the benefit of routine postpartum thromboprophylaxis

• The history of heparin and coumadin

00:00:34 Treating Mild Hypertension in Pregnancy

00:06:14 Distinguishing Chronic vs. Gestational Hypertension

00:15:46 Male Partner Treatment for Recurring BV

00:27:09 Understanding Bacterial Vaginosis Pathophysiology

00:35:42 Ineffective Treatments and Alternative Approaches

00:53:04 Tylenol in Pregnancy: Debunking ADHD Claims

00:58:02 Postpartum Thromboprophylaxis: Evidence Against Overuse

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This episode features our favorite podcast ninja, Dr. Maddie White. She and Howard discuss how medical dramatizations misrepresent obstetric emergencies (yes, we are watching The Pitt). Then, we dissect evidence-based approaches to common triage scenarios including labor evaluation, rupture of membranes, and preterm labor assessment.

• Television shows like "The Pitt" and "ER" portray shoulder dystocia and postpartum hemorrhage inaccurately, lacking proper urgency and technique
• Hospital-based labor triage often costs approximately 10 times more than office-based evaluation, often without clinical benefit
• Understanding pretest probability fundamentally changes how test results should be interpreted for suspected rupture of membranes
• Most expensive tests like Amnisure (>$500) provide minimal additional value over traditional approaches when interpreted properly
• Evidence doesn't support routine use of fetal fibronectin testing in preterm labor evaluation
• We discuss universal cervical length screening for prevention of preterm labor in the midtrimester and later in pregnancy for evaluation of threatened preterm labor

00:00:53 Critiquing Obstetric Emergencies in TV Shows

00:10:13 Proper Management of Shoulder Dystocia

00:14:52 Postpartum Hemorrhage Management Approaches

00:19:59 Evaluating Term Labor Complaints

00:25:35 Rupture of Membranes Testing Strategies

00:34:12 Understanding Test Probability and Performance

00:42:26 Cervical Length Screening Evidence

00:51:23 Preterm Labor Triage Tools

01:00:23 Concluding Thoughts on Evidence-Based Practice

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Antonia Roberts and Howard Herrell review several new articles:

• Epifoam for postpartum pain lacks evidence of effectiveness compared to simple ice packs while costing nearly $100 per unit
• AMH levels above 5.39 are associated with PCOS diagnosis, providing a specific threshold for clinical use
• External aortic compression demonstrated as a life-saving technique during severe obstetric hemorrhage
• Vaginal estrogen in breast cancer survivors shows no increased risk of cancer recurrence or mortality
• Delayed cord clamping in preterm twins reduces mortality by 30% and significantly decreases transfusion needs

Then they discuss new birth control options while questioning the value of expensive pharmaceutical products compared to established, less costly alternatives.

• New birth control options like Balcoltra ($280/month), FemLyv ($215/month), and Nextstellis ($250/month) offer minimal innovation over generic alternatives costing $10-15/month
• Marketing terms like "bioidentical" and "plant-based" are often misleading as all hormonal contraceptives are synthesized from plant precursors
• Progestin-only pills like Slynd provide only marginal DVT risk reduction (5 vs 4 per 100,000 person-years) compared to low-dose combined pills

Check our Instagram for more information and join us again in two weeks for our next episode.

00:00:00 Introduction and Epifoam Discussion

00:06:27 Financial Impact of Unnecessary Treatments

00:11:09 AMH Levels for PCOS Diagnosis

00:15:11 External Aortic Compression for Hemorrhage

00:20:22 Vaginal Estrogen and Delayed Cord Clamping

00:21:51 New Birth Control Products Overview

00:31:05 Analyzing Dissolvable Birth Control Pills

00:34:22 Slynd: Drosperinone-Only Pill Evaluation

00:42:09 Nextstellis and "Bioidentical" Estrogen Claims

00:56:37 History of Birth Control Development

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We discuss the pressing issues surrounding operative vaginal deliveries, including trends in their usage and the disparities impacting delivery outcomes. Join us as we navigate these critical insights with expert guests Jamie Perry and Howard Herrell, revealing the complexities and nuances surrounding forceps and vacuum deliveries.

• Examining the historical context of operative vaginal deliveries
• Analyzing the decline in forceps and vacuum usage since the 1990s
• Discussing the rise of cesarean deliveries as an alternative
• Revealing racial disparities adjacent to delivery practices
• Outlining effective techniques for both forceps and vacuum-assisted deliveries

Learn more about this pressing topic and gain valuable insights by listening to our episode.

00:00:00 ntroduction and Overview of the Episode

00:01:18 The Decline in Operative Vaginal Deliveries

00:05:24 Forceps

00:24:21 Vacuums

00:49:30 Advice For Trainees

00:55:38 Four Tips for Forceps and Vacuums

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This episode dives into the debate surrounding the efficacy and cost of barbed sutures in surgical practice, questioning whether their time-saving advantages are justified compared to traditional techniques, especially for uterine closure. Additionally, it explores the implications of non-invasive prenatal testing for cancer detection and recent maternal mortality statistics, while advocating for evidence-based practices in both surgical and obstetric care.

• Analysis of barbed suture use and cost implications

• Discussion of unexpected cancer detection via NIPS

• Exploration of maternal mortality statistics and misconceptions

• The relative value of baby (a discussion of the perverse economics of pediatric and obstetric care)

• Summary of recent findings on aspirin dosages for preeclampsia

• Examination of venous thromboembolism risks with hormonal contraceptives

00:00:01 Barbed Suture in OBGYN Surgery

00:09:13 Comparing Surgical Sutures

00:17:11 NIPS Results and Maternal Cancer Detection

00:24:04 Maternal Mortality Trends and Data Analysis

00:38:50 Medical Reimbursements and Healthcare Priorities

00:47:20 Risk Factors in Birth Control Thromboembolism

00:54:37 Birth Control and Thromboembolism Risk

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Join Howard with guest host Jacqueline Vidosh as we explore the challenges of maternal cardiac arrest. This episode emphasizes the urgent need for specialized training in obstetric life support. From discussing causes of maternal mortality to sharing practical tips for first responders, the insights presented aim to enhance awareness and preparedness in critical situations.

• Discussing the alarming rise in maternal mortality rates
• Identifying common causes of maternal cardiac arrest
• The importance of OBLS training and education for healthcare providers
• Emphasizing the need for left uterine displacement during resuscitation
• Addressing healthcare disparities affecting Black women
• Sharing unique physiological adaptations in pregnant patients
• Strategies for improving outcomes in maternal cardiac arrest cases
• Highlighting the value of simulation training for all healthcare personnel

Every healthcare professional plays a role in improving maternal health outcomes. Listen in for tips and insights on how we can enhance readiness for maternal cardiac arrest situations.

00:00:01 Obstetric Life Support

00:03:34 Maternal Mortality and OBLS Training

00:15:23 Maternal Health Disparities and Physiologic Changes

00:27:53 Cesarean Delivery and Post-Delivery Care

00:41:15 History and Implementation of CPR

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In this episode, Howard and Antonia focuses on the evolving guidelines for HPV screening and the implications for women's health, highlighting its superior effectiveness over traditional Pap smear tests. Additionally, we explore the reliability of pregnancy apps for information and address a listener question about Group B Streptococcus screening and management.

• Discusses the transition to HPV testing as primary cervical cancer screening
• Reviews a recent study confirming HPV's effectiveness in preventing cervical cancer
• Examines the reliability and misinformation in pregnancy apps
• Answers listener questions regarding Group B Streptococcus management

00:00:01 Circumvallate Placenta

00:13:51 Evaluating Pregnancy Apps for Accuracy

00:26:56 Evaluating Risks of Pregnancy Apps

00:36:51 Gestational Diabetes Treatment Options

00:45:47 Manage GBS Risk Factors

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